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Gastrointestinal Flashcards

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1
Q

What are antacids used for?

A

GERD and peptic ulcer disease

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2
Q

What do Calcium based antacids require for absorption?

A

Vitamin D

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3
Q

When using antacids, how long is acidity reduced when the patient is fasting?

A

20-40 minutes

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4
Q

When using antacids, how long is acidity reduced after a meal?

A

2-3 hours

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5
Q

When are calcium based antacids contraindicated?

A

If the patient is hypercalcemic or has renal calculi.

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6
Q

When are magnesium based antacids contraindicated?

A

In patients with renal failure or renal insufficiency

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7
Q

When are Aluminum based antacids contraindicated?

A

In renal patients who are on dialysis

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8
Q

What is a common ADR in Mg-based antacids?

A

Diarrhea

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9
Q

What is a common ADR in Ca and Al based antacids?

A

Constipation

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10
Q

When recommending antacids, what should you consider in regards to sodium content?

A

The sodium content may adversely affect patients with hypertension, CHF, and/or renal failure.

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11
Q

What should you tell patients to do to prevent antacids from affecting the absorption of other medications?

A

Separate antacid administration from other drugs by at least 2 hours.

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12
Q

Besides GERD and PUD, what are some other uses for antacids?

A

Hyperphosphatemia and calcium deficiency

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13
Q

What are some major things to monitor when your patients are taking antacids?

A

Signs of GI bleed, Mg levels in elderly patients

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14
Q

What is the name of the only currently available absorbent antidiarrheal?

A

Bismuth subsalicylate

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15
Q

What are the names of the opioid antidiarrheals?

A

Lomotil, Motofen, and Imodium

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16
Q

What is a major ADR of opioid antidiarrheals, such as Lomotil, Motofen, and Imodium?

A

They can decrease intestinal motility and cause toxic megacolon

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17
Q

For whom is Bismuth subsalicylate contraindicated?

A

Children with viral or flu-like symptoms

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18
Q

For whom are most antidiarrheals contraindicated?

A

Children

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19
Q

What pregnancy category do all antidiarrheals except Imodium fall under?

A

Pregnancy category C

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20
Q

What is the pregnancy category of Imodium?

A

Pregnancy category B

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21
Q

What are some weird ADRs of Bismuth subsalicylate?

A

Black tongue and grey-black stools

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22
Q

What are some major drug interactions to be aware of when prescribing Bismuth subsalicylate?

A

There is a risk of toxicity when it is taken with aspirin, and there is a risk of hypoglycemia when it is taken with insulin or oral hypoglycemics

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23
Q

Which antidiarrheal should be prescribed for acute diarrhea in adults?

A

Any antidiarrheal will work

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24
Q

Which antidiarrheal may be prescribed as an adjunct therapy in patients with bowel disease?

A

Imodium

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25
Which antidiarrheal should be prescribed for chronic infantile diarrhea?
Bismuth subsalicylate
26
Which antidiarrheal should be prescribed for traveler's diarrhea?
Bismuth subsalicylate
27
What things should you teach to the patient who is taking antidiarrheals?
Be alert for rebound constipation, black tongue and stools for those taking Bismuth subsalicylate, Lomotil and Motofen may cause dryness since they have atropine
28
What are the names of the two major cytoprotective agents?
Sulcrafate and Misoprostol
29
What is the pregnancy category for Sulcrafate?
Pregnancy category B
30
What is the pregnancy category for Misoprostol?
Pregnancy category X (abortifacient)
31
With whom should you prescribe Misoprostol cautiously?
Renal patients
32
What is a common ADR of Sulcrafate?
Constipation
33
What are some common ADRs of Misoprostol?
Diarrhea and menstrual problems
34
What type of antacid does Misprostol interact with and what is the effect?
Mg-based antacids and it can cause diarrhea
35
Which cytoprotective agent should be prescribed if the patient requires NSAID therapy?
Misoprostol
36
How long does it take for the ulcer to heal when a patient is taking Sulcrafate?
Up to 8 weeks
37
At what time of day should patients take Sucralfate?
1 hour before meals
38
Should Misoprostol be taken with food?
Yes
39
Should Sucralfate be taken with food?
No. 1 hour before meals
40
A nurse practitioner is going to prescribe either prochloperazine or promethazine to a patient complaining of nausea and vomiting. With which patient would these be contraindicated?
A patient with Parkinson's disease and children under two years old
41
A nurse practitioner is going to prescribe either prochloperazine or promethazine to a patient complaining of nausea and vomiting. What are some major ADRs that the NP should monitor for?
Extra-pyramidal side effects and fatal respiratory depression in children under 2 years old.
42
A nurse practitioner is going to prescribe either diphenhydramine or hydroxyzine to a patient who is complaining of nausea and vomiting. What ADRs should the NP warn the patient about?
Drowsiness and anticholinergic effects such as dry mouth, blurred vision, and urinary retention
43
Which patient would be prescribed dronabinol (Marinol)?
A cancer patient suffering from nausea and vomiting related to chemotherapy treatment
44
What are some common ADRs associated with dronabinol (Marinol)?
Euphoria, depression, dizziness, paranoid thoughts, somnolence, and abnormal thoughts
45
What are some cardiac ADRs associated with dronabinol (Marinol)?
Palpitations, tachycardia, and hypotension
46
A nurse practitioner is going to prescribe dronabinol to a patient who is complaining of nausea and vomiting. She should reconsider this prescription if the patient has ______?
A seizure disorder
47
What is there a danger of if a patient is taking both promethazine and lithium?
There is an increased risk of extra-pyramidal side effects and lithium toxicity may be masked
48
Which antiemetics have a low side effect profile?
5-HT3 receptor antagonists such as palonosetron, dolasetron, granisetron, or ondansetron
49
Which antiemetic should be prescribed for motion sickness?
An antihistamine such as dimenhydrinate (Dramamine) or meclizine (Antivert)
50
How far in advance of traveling should a patient take an antiemetic?
1 to 2 hours before departure
51
What type of drug should be prescribed to the patient who is complaining of vomiting related to gastroparesis?
A prokinetic drug (Metoclopramide)
52
What should be monitored with the long-term use of promethazine?
A CBC at weeks 4 and 10 of therapy to check for bone marrow depression and blood dyscrasias
53
What are drugs such as Cimetidine, Ranitidine, Famotidine, and Nizatidine used for?
NPO patients with gastric acid, prophylaxis and management of ulcers, and GERD
54
What category of drug do Cimetidine, Ranitidine, Famotidine, and Nizatidine fall under?
Histamine 2 Receptor Antagonists
55
What is the pregnancy category for H2RAs?
Pregnancy category B
56
Which H2RAs are approved for use in children?
Ranitidine and famotidine
57
What hormonal ADRs are associated with Cimetidine?
Antiandrogenic effects such as gynecomastia and impotence
58
What CNS ADRs are associated with Cimetidine, Ranitidine, Famotidine, and Nizatidine?
confusion, agitation, psychosis, depression, and disorientation
59
What hematological ADRs are associated with Cimetidine, Ranitidine, Famotidine, and Nizatidine?
Agranulocytosis, granulocytosis, thrombocytopenia, and aplastic anemia
60
How are H2RAs metabolized?
Through the liver, which can cause many different drug interactions
61
Should H2RAs be prescribed for peptic ulcer disease?
No
62
Should H2RAs be prescribed to patients with renal dysfunction?
Yes, but with caution and at a lower dose
63
Should H2RAs be taken with food?
Yes
64
What is the only prokinetic drug currently on the market?
Metoclopramide
65
What is the black box warning on metoclopramide?
Risk for development of tardive dyskinesia
66
With which patients is metoclopramide contraindicated?
Patients with GI hemorrhage, mechanical obstruction, new surgery on the GI tract, or perforation
67
What is the pregnancy category for metoclopramide?
Pregnancy category B
68
What psychological issue should the NP monitor for in patients taking metoclopramide?
Depression and suicidal ideation
69
What should the NP be alert for in diabetic patients taking metoclopramide?
Hypoglycemia
70
Which disorders indicate the use of metoclopramide?
GERD and diabetic gastroparesis
71
What should the NP monitor in patients taking metoclopramide?
Renal function, signs of tardive dyskinesia, depression and suicide ideation
72
At what time of day should patients take metoclopramide?
30 minutes before meals
73
With which disorders are proton pump inhibitors (PPIs) indicated?
Erosive gastritis, GERD, Zollinger-Ellison syndrome, active PUD, ulcers caused by H. pylori
74
What is an example of a proton pump inhibitor (PPI)?
Omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole
75
What is the pregnancy category of PPIs except omeprazole?
Pregnancy category B
76
What is the pregnancy category of omeprazole?
Pregnancy category C
77
Which PPIs can be used in children as young as 1 year old?
Esomeprazole, omeprazole, and lansoprazole
78
Which PPIs cannot be used in children under 12 years old?
Pantoprazole and rabeprazole
79
What has long-term PPI use been linked to?
Increased risk for osteoporosis and hip fractures
80
Because PPIs decreases gastric acid secretions, patients taking these medications are at a risk develop which insufficiencies?
Iron, vitamin B12, and calcium
81
Which drug has a black box warning for patients taking omeprazole?
Clopidogrel (Plavix), which has decreased effectiveness when patients are also taking omeprazole
82
A combination of PPIs and ______ are used to treat _____ infections.
Antibiotics, H. pylori
83
How long should patients take PPIs when it is prescribed for GERD?
8 weeks
84
Which type of laxative is contraindicated in patients with renal dysfunction?
Magnesium hydroxide
85
Laxatives are contraindicated in the presence of which disorders?
Nausea, vomiting, undiagnosed abdominal pain, suspected bowel obstruction
86
Which laxatives are the drug of choice for rapid response and short term use?
Senna, bisocodyl, docusate, magnesium hydroxide
87
Which laxatives are the drug of choice for long term therapy?
Psyllium, methylcellulose, polycarbophil
88
Which laxatives are the safest for pregnant patients?
Psyllium, methylcellulose, polycarbophil
89
What is the order for prescribing medication in the step up approach for patients with GERD?
1. Antacids 2. H2RAs 3. PPIs
90
What is the order for prescribing medication in the step down approach for patients with GERD?
1. PPIs for 8 weeks 2. if better, switch to H2RAs 2b. if worse, increase PPI dose

Pharmacology (6 decks)

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